Attention-guided deep neural network with a multichannel architecture for lung nodule classification.

Detecting and accurately identifying malignant lung nodules in chest CT scans in a timely manner is crucial for effective lung cancer treatment. This study introduces a deep learning model featuring a multi-channel attention mechanism, specifically designed for the precise diagnosis of malignant lung nodules. To start, we standardized the voxel size of CT images and generated three RGB images of varying scales for each lung nodule, viewed from three different angles. Subsequently, we applied three attention submodels to extract class-specific characteristics from these RGB images. Finally, the nodule features were consolidated in the model's final layer to make the ultimate predictions. Through the utilization of an attention mechanism, we could dynamically pinpoint the exact location of lung nodules in the images without the need for prior segmentation. This proposed approach enhances the accuracy and efficiency of lung nodule classification. We evaluated and tested our model using a dataset of 1018 CT scans sourced from the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI). The experimental results demonstrate that our model achieved a lung nodule classification accuracy of 90.11 %, with an area under the receiver operator curve (AUC) score of 95.66 %. Impressively, our method achieved this high level of performance while utilizing only 29.09 % of the time needed by the mainstream model.

Ethiodized poppyseed oil-based contrast medium is superior to water-based contrast medium during hysterosalpingography regarding image quality improvement and fertility enhancement: A multicentric, randomized and controlled trial.

Background: The efficacy of ethiodized poppyseed oil in hysterosalpingography (HSG) image quality and fertility enhancement has been revealed, but whether this HSG modality has similar effects in the Chinese population is still unclear. Methods: Between July 18, 2017, and December 29, 2019, this multicentric, randomized, two-arm, clinical trial was performed involving 15 medical centers. Infertile women meeting HSG indications were randomly assigned to an oil group and a water group. The coprimary outcome included HSG image quality during HSG and fertility-enhancing effects of HSG. This study was registered on ClinicalTrials.gov (NCT03370575). Findings: A total of 1026 subjects were randomly assigned to an oil group (N = 508) and a water group (N = 518). HSG image quality revealed that the oil group had outstanding visualization (all P < 0.001); total image quality scores for uterus opacification or uterine outline (2.9 ± 0.4 vs. 2.7 ± 0.5), fallopian tube outline (2.3 ± 0.8 vs. 1.7 ± 0.7), fimbrial rugae (1.7 ± 1.0 vs. 1.3 ± 0.8), fallopian tube spillage (2.1 ± 0.9 vs. 1.6 ± 0.8), peritoneal distribution (2.6 ± 0.9 vs. 2.1 ± 1.0) and diagnostic quality (11.6 ± 3.4 vs. 9.5 ± 3.1) (all P < 0.001) were higher in the oil group than in the water group. Regarding fertility-enhancing evaluation, the oil group showed an increased cumulative on-going pregnancy rate, on-going pregnancy within 6 months (29.1% vs. 20.1%), clinical pregnancy (39.5% vs. 29.1%) and live birth ≥ 24 weeks of gestation (36.1% vs. 27.7%) but a shorter time to pregnancy than the water group (all P < 0.01). Concerning adverse events, the oil group showed a lower occurrence rate of abdominal pain and vaginal bleeding after HSG (both P < 0.01). Interpretation: Ethiodized poppyseed oil-based contrast is superior to water-based contrast during HSG in terms of image quality improvement and fertility enhancement. This study indicates the priority of the application of ethiodized poppyseed oil-based contrast during the HSG procedure in infertile patients. Funding: No funding was received.

Clinico-Radiological Features and Outcomes in Pregnant Women with COVID-19 Pneumonia Compared with Age-Matched Non-Pregnant Women.

PURPOSE: To investigate the clinico-radiological findings and outcomes in pregnant women with COVID-19 pneumonia compared to age-matched non-pregnant women. METHODS: A retrospective case-controlled study was conducted to review clinical and CT data of 21 pregnant and 19 age-matched non-pregnant women with COVID-19 pneumonia. Four stages of CT images were analyzed and compared based on the time interval from symptom onset: stage 1 (0-6 days), stage 2 (7-9 days), stage 3 (10-16 days), and stage 4 (>16 days). The initial and follow-up data were analyzed and compared. RESULTS: Compared with age-matched non-pregnant women, initial absence of fever (13/21, 62%) and normal lymphocyte count (11/21, 52%) were more frequent in pregnant group. The predominant patterns of lung lesions were pure ground-glass opacity (GGO), GGO with consolidation or reticulation, and pure consolidation in both groups. Pure consolidation on chest CT was more common at presentation in pregnant cases. Pregnant women progressed with a higher consolidation frequency compared with non-pregnant group in stage 2 (95% vs 82%). Improvement was identified in stages 3 and 4 for both groups, but consolidation was still more frequent for pregnant women in stage 4. Most patients (38/40, 95%) were grouped as mild or common type. The length of hospitalization between the two groups was similar. CONCLUSION: Pregnant women with COVID-19 pneumonia did not present typical clinical features, while developing a relatively more severe disease at imaging with a slower recovery course and experiencing similar outcomes compared with the non-pregnant women.

Asymptomatic and Symptomatic Patients With Non-severe Coronavirus Disease (COVID-19) Have Similar Clinical Features and Virological Courses: A Retrospective Single Center Study.

The current outbreak of coronavirus disease 2019 (COVID-19) has been defined as a pandemic by the World Health Organization. We aimed to evaluate the clinical features and virological course of non-severe COVID-19 patients with or without symptoms who were admitted to a Chinese cabin hospital. In this retrospective single center study, we reviewed 252 laboratory-confirmed COVID-19 patients treated at one temporary cabin hospital in Wuhan, China. Demographic, clinical, serial chest computed tomography (CT), and serial viral test data were compared between asymptomatic and symptomatic patients. The association between clinical features and symptomatic status or patient referral status was analyzed. Among all 252 patients, 74 (29.4%) were asymptomatic and 138 (54.76%) had more than two family members who developed COVID-19. The probability for family clustering was similar between asymptomatic and symptomatic patients (59.70 vs. 61.64%, P = 0.79). Asymptomatic patients and symptomatic patients were equally likely to reach a virus-free state during their stay at the cabin hospital (93.15 vs. 86.44%, P = 0.13). The initial chest CT screening showed that 81 (32.1%) patients had no visible pneumonia, 52 (20.6%) had unilateral pneumonia, and 119 (47.2%) had bilateral pneumonia. Symptomatic patients had a higher chance to have bilateral pneumonia (P < 0.0001) and were less likely to show improvement on the follow-up CT scan (P = 0.0002). In total, 69 (27.4%) patients were referred to the designated hospital and only 23 (9.1%) patients were referred due to the progression of pneumonia. Non-severe COVID-19 patients can transmit the disease regardless of their symptomatic status. It is highly recommended that asymptomatic patients be identified and quarantined to eliminate the transmission of COVID-19.

Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children.

BACKGROUND: The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported. METHODS: Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared. FINDINGS: Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans. INTERPRETATION: Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.

Randomized controlled trial of hysteroscopy or ultrasonography versus no guidance during D&C after uterine artery chemoembolization for cesarean scar pregnancy.

OBJECTIVE: To compare the complication rates after uterine artery chemoembolization (UACE) followed by dilation and curettage (D&C) guided by different types of monitoring for treatment of cesarean scar pregnancy (CSP). METHODS: A randomized controlled trial was undertaken of women with CSP attending a hospital in Wuhan, China, between June 1, 2010, and June 30, 2014. Using sealed opaque envelopes containing random numbers, participants were randomly allocated to undergo D&C with hysteroscopy monitoring, ultrasonography monitoring, or no monitoring. Participants and investigators were masked to group assignment. The primary outcome was the number of participants with complications at 2 months of follow-up after D&C. Analyses were by intention to treat. RESULTS: Among 144 participants, 48 were assigned to hysteroscopy monitoring, 44 to ultrasonography monitoring, and 52 to no monitoring. Complications were noted for 1 (2.1%) patient in the hysteroscopy group, 2 (4.5%) in the ultrasonography group, and 12 (23.1%) in the no monitoring group (P=0.001). CONCLUSION: Hysteroscopy or ultrasonography monitoring of D&C after UACE for CSP treatment can decrease the complication rate. ClinicalTrials.gov: NCT02357095.

Bilateral uterine artery chemoembolization combined with dilation and curettage for treatment of cesarean scar pregnancy: A method for preserving the uterus.

AIM: The aim of this study was to respectively evaluate the feasibility and safety of bilateral uterine artery chemoembolization (UACE) combined with dilation and curettage (D&C) for the treatment of cesarean scar pregnancy (CSP). MATERIAL AND METHODS: Our study was approved by our institutional review board, with informed patient consent. From January 2004 to December 2010, 79 patients with CSP underwent UACE in our institution, with transcatheter infusion of 30-50 mg methotrexate into the bilateral uterine artery before embolization with sponge particles. Within 24-48 h after UACE, D&C was performed on all the patients under the guidance of ultrasonography and hysteroscopy. RESULTS: All the 79 patients diagnosed as having CSP were included in our study and their data were analyzed. All the patients recovered completely without severe complications. The average hemorrhage volume during D&C was 30 mL, but none of them needed transfusion. The uteri of all the patients were preserved, and none of them had to undergo hysterectomy. The safety rate was 100%. The mean duration of hospital stay was 10.5 days. CONCLUSIONS: UACE performed prior to D&C is a feasible method and it may reduce hemorrhage complications and risk of hysterectomy in patients with CSP.